Healthcare Provider Details

I. General information

NPI: 1073244182
Provider Name (Legal Business Name): NANCY PATRICIA TORRES MEDINA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N 3RD ST
GOSHEN IN
46528-7100
US

IV. Provider business mailing address

16106 BRUNSWICK DR
GOSHEN IN
46526-8933
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-0088
  • Fax:
Mailing address:
  • Phone: 574-312-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number363LF0000X
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012789A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: